Facial implants are used to enhance certain features of the face and aesthetically improve the facial contours by improving proportions and profile as well as correcting imbalances caused by injury or hereditary traits. These procedures are usually performed under local or general anesthetic on an outpatient basis.
The procedure involves the placement of usually synthetic materials under the subcutaneous tissue and onto the underlying bone. There are several different types of materials used for this purpose including:
- High-density porous polyethylene; and
- Expanded polytetrafluoroethylene.
The most common types of facial implants are cheek and chin implants with lower jaw and paranasal implants seeing less popularity.
Cheek implants are meant to increase the projection of the cheekbones and add volume to recessed or flat areas. For this procedure the implant is placed internally through the upper lip or externally through the lower eyelid. An incision is cut through which the surgeon slides the implant into place over the cheekbone. This is often performed with other procedures which may help to determine the placement of the sutures.
Material: Most implants are made of silicone but both expanded polytetrafluoroethylene and high- density porous polyethylene offer better integration with the underlying bone and tissue.
Shape: There are three general shapes of cheek implants: malar, submalar, and combined. Malar implants are the most common and are placed directly on the cheekbone to add projection and create a higher contour. Submalar are not placed on the cheekbone but rather are used to augment the mid-face. Combined implants augment both the cheekbone and the mid-face by combining these two types.
Incisions: Most commonly the incisions are placed in the upper mouth area near the top of the gum line as this prevents visible scars. However, incisions in the mouth are more prone to infection. Alternatively the incision can be external and placed near the eye but this is a less popular option due to the visible scarring.
Risks: Cheek implants carry the usual risks associated with surgical procedures including:
- Postoperative bleeding;
- Formation of blood clots;
- Severe swelling; and
- Temporary or extended loss of sensation.
- Asymmetry of features after the operation is also a rare but possible side effect. This can be caused by uneven absorption, implant displacement, or shifting caused by swelling, trauma, or scarring.
Alternatives: Fillers and injections are popular alternatives to cheek implants as they are less invasive and less expensive but they do have less dramatic results. Injections can be done with hyaluronic acid or autologous fat transfer with the fat transfer being the more permanent option.
Chin implants are placed internally through the lower lip or externally under the chin and the sutures will depend upon the incision point. This procedure is performed in order to alter the size and projection of the chin if it is not proportional to the rest of the patient’s facial features. Reductions in the projection of a patient’s chin are referred to as mentoplasty while additions (implants) are referred to as genioplasty. This procedure is often performed at the same time as a rhinoplasty and is a relatively easy operation for the patient while providing dramatic results.
Material: These implants are often made from the patient’s own bone donated from the ribs and part of the pelvis but this is associated with a higher risk of infection than synthetic materials.
Risks: The risks for this procedure are relatively minor and include many of those associated with undergoing a surgical procedure of any kind:
- Numbness of the lower lip;
- Bone changes; and
- Displacement of the implant.
Recovery: Due to the placement of the implant and incision chewing should be kept to a minimum for several days so be sure to stock up on some healthy smoothie or other food replacement beverages. Remember not to use a straw if you sutures are internal to the mouth or you may rip them out!
These implants are intended to increase the width of the lower third of the face and are placed inside of the lower lip. The incision site is secured with sutures which dissolve in about a week. As with chin implants, these implants may require a more careful recovery period and limited chewing for several days following surgery.